Ankle Pain

Bone spurs (aka bone cysts) along with ligament fibrosis and tendinosis often occur over long periods of chronic ankle instability.  After conservative therapy fails to heal an arthritic ankle joint with healthy collagen-based tissue, the body will begin to lay calcium into the tendon, ligament, or bone cysts. These calcified tissues will generally infiltrate ligamentous or tendon tissues and cause them to have a “brittle stability”. For the patient, movement of the ankle may create sharp pain that resolves after activity or becomes achy with activity. Sometimes the ankle joint or ligaments and tendons can become so brittle that the entire ankle joint is impinged. The patients body is attempting to preserve stability, but at the cost of ankle flexibility and functionality with the use of calcified bone cyst or fibrosed (scarred up) ligaments and tendons. Under the microscope, a bone cyst often looks like a porous calcified tissue (it rarely looks like solid bone-periosteum).  For fibrosed ligaments and tendons, they look like twisted, knotted tissues often with calcified infiltrate under a microscope.  In contrast, healthy tendon and ligaments look like long, even lines of collagen with little to none twisted or knotting.

Treatment for bone spurs, ligament fibrosis, and tendinosis in the ankle often requires the use of sophisticated osteopathic manual therapy, active release therapy, heat and ice contrast therapy, and other more aggressive manual modalities. Often, if these therapies fail, patients may consider getting injection procedures such as percutaneous curettage or tenolysis that help break down the bone spur or fibrosis. These injection therapies can be an effective option for many patients before resorting to ankle surgery.